心血管内科住院患者感染病原菌分布与耐药性分析

Pathogen distribution and drug resistance of infections in hospitalized patients in cardiovascular medicine

目的探讨心血管内科住院患者感染的病原菌分布以及耐药性,为临床抗感染治疗提供参考依据。方法选取2013年1月-2014年1月心血管内科住院感染患者344例,采集患者血液、痰液标本等进行病原菌检测和药物敏感性试验,其中菌种鉴定采用法国生物梅里埃公司的VITEK-60全自动细菌分析仪,药物敏感试验采用K-B纸片扩散法。结果 344例感染患者检测标本中共分离出395株病原菌,其中革兰阴性菌检出232株占58.7%、革兰阳性菌129株占32.7%、真菌34株占8.6%;革兰阴性菌中大肠埃希菌及肺炎克雷伯菌对于氨基糖苷类、喹诺酮类、第三代头孢菌素等抗菌物耐药率较高,部分可达100.0%,而对头孢哌酮/舒巴坦、阿米卡星、亚胺培南的耐药率较低,分别为64.7%、64.7%及11.8%,铜绿假单胞菌及鲍氏不动杆菌对头孢唑林的耐药率均为100.0%;革兰阳性菌对克林霉素、左氧氟沙星、红霉素、青霉素的耐药率较高,均>80.0%。结论心血管内科住院患者感染以肺炎克雷伯菌、大肠埃希菌等革兰阴性菌为主要病原菌,耐药性较为复杂,存在多药耐药性,需积极采取对策降低多药耐药性的发生。

OBJECTIVE To investigate the pathogen distribution and drug resistance of the infected patients in cardiovascular medicine so as to provide references for clinical treatment .METHODS Totally 344 cases of infected patients in cardiovascular medicine from Jan .2013 to Jan .2014 were selected and their blood and phlegm samples were collected to receive pathogenic detection and drug sensitivity test .VITEK‐60 full‐automatic bacteria analyzer produced by BioMerieux was used to identify bacteria strains .K‐B paper diffusion was adopted to detect drug sensitivity .RESULTS Totally 395 strains of pathogens were isolated from the 344 samples ,including 232 strains of gram‐negative bacteria ,accounting for 58 .7% and 129 strains of gram‐positive bacteria ,accounting for 32 .7%and 34 strains of fungi ,holding 8 .6% .Escherichia coli and K lebsiella pneumonias were highly resistant to amino glycosides ,Fluoroquinolones and third‐generation cephalosporin ,some drug resistance rate up to 100 .0% ,while less resistant to cefoperazone /sulfate ,alizarin and imipenem with the drug resistance rate of 64 .7% ,64 .7% and 11 .8% respectively . Pseudomonas aerations and Acinetobacter baumannii were 100 .0% resistant to cefazolin ;Gram‐positive bacteria were highly resistant to clindamycin ,levofloxacin ,erythromycin and penicillin with the drug resistance rate of more than 80 .0% .CONCLUSION K .pneumonia ,E .coli and other gram‐negative bacteria are major pathogens causing infections in cardiovascular medicine ,and drug resistance is fairly complicated such as multi‐drug resistance .Efforts must be made to decrease the multi‐drug resistance rate .